With the advent of highly active antiretroviral therapy (HAART) and proper adherence, HIV is no longer a death sentence and can be viewed as a chronic illness. It is important to explore the factors that may promote greater longevity and better health outcomes for persons infected with HIV. There is a high prevalence of trauma history among women with HIV and those at risk, which is associated with HIV medication nonadherence, and risky sexual behaviors. However, some women may be resilient in the face of trauma, attaining adaptive behaviors in their relationships, sense of self, and work experiences. The literature has focused on factors that place women "at risk" for HIV transmission/contraction, poor health outcomes, and sexually risky behavior, and far less attention has been given to factors that may place women "at promise" for better outcomes. This proposal adds to the literature by focusing on the important understudied factor of resilience subsequent to trauma and how it relates to biological stress hormones (i.e. norepinephrine) and health outcomes among women with HIV and those at risk for HIV. The health outcomes that will be assessed for both HIV+ and at risk women include coronary heart disease risk, depression, quality of life, and for HIV+ women, specific indicators will include HIV disease progression markers and medication adherence. Norepinephrine (NE) is a neurotransmitter that plays a key role in the body's biological and behavioral response to stress and has shown significant association with HIV disease progression markers. In general, higher NE levels are linked to worse disease progression. However, little is known about how NE levels relate to positive psychosocial factors such as resilience. Among women with and at risk for HIV who have experienced trauma, the proposed study will examine the relationships between resilience and health outcomes, testing whether resilience also relates to NE levels and whether NE may serve as a mediator of these relationships. The findings may better inform the development of more effective prevention, intervention strategies and good health outcomes, decreasing morbidity and mortality rates. PUBLIC HEALTH RELEVANCE: Improving the health outcomes among women with or at risk for HIV is a critical public health issue. Understanding the relationships between resilience and biological stress hormones (i.e. norepinephrine) in women with HIV who have experienced trauma may better inform the development of more effective prevention, intervention strategies and good health outcomes.